Drug Maintenance –

Senior Preferred allows members to fill their medications in a supply greater than 30 days. We allow up to a 90-day supply per fill for drugs within tiers 1-4. Each 30-day supply will take one copay (a 90-day supply equals 3 copays) at a retail pharmacy.

See the mail order page for information on getting a better copayment through the mail order program.

Scroll down to view 2018 Copayment Amounts.


2019 Copayment Amounts


2019 UW Health Elite D Copayment Amounts

Annual Description Deductible

There is no deductible.

Initial Coverage

You begin in this stage when you fill your first prescription of the year. During this stage, the plan pays its share of the cost of your drugs and you pay your share of the cost. You stay in this stage until your year-to-date: “total drug costs” (your payments plus any Part D plan’s payments) total $3,820.

Mail order pharmacy copayment amounts are also noted below.

  • Tier 1 - (Preferred Generic) Copayment Amounts   
    • Retail Pharmacy
      • One-month (30 day) supply - $6
      • Three-month (90 day) supply - $18
    • Mail Order Pharmacy
      • Three-month (90 day) supply - $15

       

    • Tier 2 - (Generic) Copayment Amounts   
      • Retail Pharmacy
        • One-month (30 day) supply - $15
        • Three-month (90 day) supply - $45
      • Mail Order Pharmacy
        • Three month (90 day) supply - $38

         

      • Tier 3 - (Preferred Brand) Copayment Amounts
        • Retail Pharmacy
          • One-month (30 day) supply - $47
          • Three-month (90 day) supply - $141
        • Mail Order Pharmacy
          • Three month (90 day) supply - $118

           

        • Tier 4 - (Non-Preferred Brand Name) Copayment Amounts
          • Retail Pharmacy
            • One-month (30 day) supply - You pay 40% of the cost.
            • Three-month (90 day) supply - You pay 40% of the cost.
          • Mail Order Pharmacy
            • Three month (90 day) supply - You pay 40% of the cost.

             

          • Tier 5 - (Specialty Medications) Copayment Amounts
            • Retail Pharmacies
              • One-month (30 day) supply - You pay 25% of the cost.
              • We do not cover three-month (90 day) supplies of Tier 5 medications at retail pharmacies. 
            • Mail Order Pharmacy
              • One-month (30 day) supply - You pay 25% of the cost.
              • We do not cover three-month (90 day) supplies of Tier 5 medications through mail order pharmacy.

          If you reside in a long-term care facility, you pay the same as at a retail pharmacy.

          You may get drugs from at out-of-network pharmacy, but you may pay more than you pay at an in-network pharmacy.

          Coverage Gap

          During this stage, you pay 25% of the price for brand name drugs (plus a portion of the dispensing fee) and 37% of the price for generic drugs. You stay in this stage until your year-to-date “out-of-pocket costs” (your payments) reach a total of $5,100. This amount and rules for counting costs toward this amount have been set by Medicare.

          Catastrophic Coverage

          After your yearly out-of-pocket drug costs reach $5,100, you pay the greater of 5% of the drug cost or $3.40 copay for generic drugs or $8.50 for brand drugs.

          2019 UW Health Value D Copayment Amounts

          Annual Description Deductible

          There is no deductible.

          Initial Coverage

          You begin in this stage when you fill your first prescription of the year. During this stage, the plan pays its share of the cost of your drugs and you pay your share of the cost. You stay in this stage until your year-to-date: “total drug costs” (your payments plus any Part D plan’s payments) total $3,820.

          Mail order pharmacy copayment amounts are also noted below.

          • Tier 1 - (Preferred Generic) Copayment Amounts   
            • Retail Pharmacy
              • One-month (30 day) supply - $6
              • Three-month (90 day) supply - $18
            • Mail Order Pharmacy
              • Three-month (90 day) supply - $15
            • Tier 2 - (Generic) Copayment Amounts   
              • Retail Pharmacy
                • One-month (30 day) supply - $15
                • Three-month (90 day) supply - $45
              • Mail Order Pharmacy
                • Three month (90 day) supply - $38
            • Tier 3 - (Preferred Brand) Copayment Amounts   
              • Retail Pharmacy
                • One-month (30 day) supply - $47
                • Three-month (90 day) supply - $141
              • Mail Order Pharmacy
                • Three month (90 day) supply - $118
              • Tier 4 - (Non-Preferred Brand Name) Copayment Amounts
                • Retail Pharmacy
                  • One-month (30 day) supply - You pay 40% of the cost.
                  • Three-month (90 day) supply - You pay 40% of the cost.
                • Mail Order Pharmacy
                  • Three month (90 day) supply - You pay 40% of the cost.
                • Tier 5 - (Specialty Medications) Copayment Amounts
                  • Retail Pharmacies
                    • One-month (30 day) supply - You pay 25% of the cost.
                    • We do not cover three-month (90 day) supplies of Tier 5 medications at retail pharmacies. 
                  • Mail Order Pharmacy
                    • One-month (30 day) supply - You pay 25% of the cost.
                    • We do not cover three-month (90 day) supplies of Tier 5 medications through mail order pharmacy.

                If you reside in a long-term care facility, you pay the same as at a retail pharmacy.

                You may get drugs from at out-of-network pharmacy, but you may pay more than you pay at an in-network pharmacy.

                Coverage Gap

                During this stage, you pay 25% of the price for brand name drugs (plus a portion of the dispensing fee) and 37% of the price for generic drugs. You stay in this stage until your year-to-date “out-of-pocket costs” (your payments) reach a total of $5,100. This amount and rules for counting costs toward this amount have been set by Medicare.

                Catastrophic Coverage

                After your yearly out-of-pocket drug costs reach $5,100, you pay the greater of 5% of the drug cost or $3.40 copay for generic drugs or $8.50 for brand drugs.

                2018 Copayment Amounts


                Elite D - 2018 Copayment Amounts

                Annual Description Deductible

                Initial Coverage 

                Before the total yearly drug costs (paid by both you and Senior Preferred Elite D) reach $3,750, you pay the following amounts for prescription drugs when they are filled at a retail pharmacy.

                Mail order pharmacy copayment amounts are also noted below.

                Initial Coverage

                • Tier 1 - (Preferred Generic) Copayment Amounts   
                  • Retail Pharmacy
                    • One-month (30 day) supply - $6
                    • Three-month (90 day) supply - $18
                  • Mail Order Pharmacy
                    • Three-month (90 day) supply - $15

                     

                  • Tier 2 - (Generic) Copayment Amounts   
                    • Retail Pharmacy
                      • One-month (30 day) supply - $15
                      • Three-month (90 day) supply - $45
                    • Mail Order Pharmacy
                      • Three month (90 day) supply - $38

                       

                    • Tier 3 - (Preferred Brand) Copayment Amounts   
                      • Retail Pharmacy
                        • One-month (30 day) supply - $47
                        • Three-month (90 day) supply - $141
                      • Mail Order Pharmacy
                        • Three month (90 day) supply - $118

                         

                      • Tier 4 - (Non-Preferred Brand Name) Copayment Amounts
                        • Retail Pharmacy
                          • One-month (30 day) supply - You pay 40% of the cost.
                          • Three-month (90 day) supply - You pay 40% of the cost.
                        • Mail Order Pharmacy
                          • Three month (90 day) supply - You pay 40% of the cost.

                           

                        • Tier 5 - (Specialty Medications) Copayment Amounts
                          • Retail Pharmacies
                            • One-month (30 day) supply - You pay 25% of the cost.
                            • We do not cover three-month (90 day) supplies of Tier 5 medications at retail pharmacies. 
                          • Mail Order Pharmacy       
                            • One-month (30 day) supply - You pay 25% of the cost.
                            • We do not cover three-month (90 day) supplies of Tier 5 medications through mail order pharmacy.

                        If you reside in a long-term care facility, you pay the same as at a retail pharmacy.

                        You may get drugs from at out-of-network pharmacy, but you may pay more than you pay at an in-network pharmacy.

                        Coverage Gap

                        Most Medicare drug plans have a coverage gap (also called the “donut hole”). This means that there’s a temporary change in what you will pay for your drugs. The coverage gap begins after the total yearly drug cost (including what our plan has paid and what you have paid) reaches $3,750.

                        After you enter the coverage gap, you pay 35% of the plan’s cost for covered brand name drugs and 44% of the plan’s cost for covered generic drugs until your costs total $5,000 which is the end of the coverage gap. Not everyone will enter the coverage gap.

                        Catastrophic Coverage

                        After your yearly out-of-pocket drug costs reach $5,000, you pay the greater of 5% of the drug cost or $3.35 copay for generic drugs or $8.35 for brand drugs.

                        2018 UW Health Value D Copayment Amounts

                        Annual Description Deductible

                        You pay the following until your total yearly drug costs reach $3,750. Total yearly drug costs are the total drug costs paid by both you and our Part D plan.

                        You may get your drugs at network retail pharmacies.

                        Initial Coverage

                        • Tier 1 - (Preferred Generic) Copayment Amounts   
                          • Retail Pharmacy
                            • One-month (30 day) supply - $6
                            • Three-month (90 day) supply - $18
                          • Mail Order Pharmacy
                            • Three-month (90 day) supply - $15
                          • Tier 2 - (Generic) Copayment Amounts   
                            • Retail Pharmacy
                              • One-month (30 day) supply - $15
                              • Three-month (90 day) supply - $45
                            • Mail Order Pharmacy
                              • Three month (90 day) supply - $38
                          • Tier 3 - (Preferred Brand) Copayment Amounts   
                            • Retail Pharmacy
                              • One-month (30 day) supply - $47
                              • Three-month (90 day) supply - $141
                            • Mail Order Pharmacy
                              • Three month (90 day) supply - $118

                               

                            • Tier 4 - (Non-Preferred Brand Name) Copayment Amounts
                              • Retail Pharmacy
                                • One-month (30 day) supply - You pay 40% of the cost.
                                • Three-month (90 day) supply - You pay 40% of the cost.
                              • Mail Order Pharmacy
                                • Three month (90 day) supply - You pay 40% of the cost.

                                 

                              • Tier 5 - (Specialty Medications) Copayment Amounts
                                • Retail Pharmacies
                                  • One-month (30 day) supply - You pay 25% of the cost.
                                  • We do not cover three-month (90 day) supplies of Tier 5 medications at retail pharmacies. 
                                • Mail Order Pharmacy       
                                  • One-month (30 day) supply - You pay 25% of the cost.
                                  • We do not cover three-month (90 day) supplies of Tier 5 medications through mail order pharmacy.

                              If you reside in a long-term care facility, you pay the same as at a retail pharmacy.

                              You may get drugs from at out-of-network pharmacy, but you may pay more than you pay at an in-network pharmacy.

                              Coverage Gap

                              Most Medicare drug plans have a coverage gap (also called the “donut hole”). This means that there’s a temporary change in what you will pay for your drugs. The coverage gap begins after the total yearly drug cost (including what our plan has paid and what you have paid) reaches $3,750.

                              After you enter the coverage gap, you pay 35% of the plan’s cost for covered brand name drugs and 44% of the plan’s cost for covered generic drugs until your costs total $5,000 which is the end of the coverage gap. Not everyone will enter the coverage gap.

                              Catastrophic Coverage

                              After your yearly out-of-pocket drug costs reach $5,000, you pay the greater of 5% of the drug cost or $3.35 copay for generic drugs or $8.35 for brand drugs.
                              This web page was updated on October 1, 2018.